Amputation

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With Thanks
Dr.Abdullah-Al-Mamun
DMCH
msn al_mamunnn@hotmail.com
Yahoo: almamun56

Published in: Health & Medicine, Business

Amputation

  1. 1. Amputation Dr. Abdullah-Al-Mamun
  2. 2. <ul><ul><li>‘ DDD’ </li></ul></ul><ul><ul><ul><li>Dead </li></ul></ul></ul><ul><ul><ul><li>Deadly </li></ul></ul></ul><ul><ul><ul><li>Dam Nuisance </li></ul></ul></ul>Indications: Amputation
  3. 3. <ul><li>Derived from the Latin amputare . </li></ul><ul><li>&quot;to cut away&quot;, from ambi- (&quot;about&quot;, &quot;around&quot;) and putare (&quot;to prune&quot;). </li></ul><ul><li>Amputation is the complete removal of an injured or deformed body part. </li></ul><ul><li>The English word &quot;amputation&quot; was first applied to surgery in the 17th century. </li></ul>Nomenclature. Amputation
  4. 4. History <ul><li>Most ancient of surgical procedure. </li></ul><ul><li>Historically were stimulated by the aftermath of war. </li></ul><ul><li>It was a crude procedure by which limb was rapidly severed from unanesthetized patient. </li></ul><ul><li>The open stamp was then crushed or dipped in boiling oil to obtain hemostasis. </li></ul><ul><li>Hippocrates was the first to use ligature. </li></ul><ul><li>Ambroise Pare ( a France military surgeon) introduced artery forceps. He also designed prosthesis. </li></ul>Amputation
  5. 5. Etiology <ul><li>Trauma </li></ul><ul><li>Burns </li></ul><ul><li>Peripheral Vascular Disease </li></ul><ul><li>Malignant Tumors </li></ul><ul><li>Neurologic Conditions </li></ul><ul><li>Infections </li></ul><ul><li>Congenital Deformities </li></ul>Amputation
  6. 6. Trauma Amputation
  7. 7. Malignant Tumor Amputation
  8. 8. Gangrene Amputation
  9. 9. Crush Amputation
  10. 10. Peripheral Vascular Disease Amputation
  11. 11. Congenial Anomaly Polydactyly Amputation
  12. 12. Scleroderma Amputation
  13. 13. Determination of level <ul><li>Zone of Injury (trauma) </li></ul><ul><li>Adequate margins (tumor) </li></ul><ul><li>Adequate circulation (vascular disease) </li></ul><ul><li>Soft tissue envelope </li></ul><ul><li>Bone and joint condition </li></ul><ul><li>Control of infection </li></ul><ul><li>Nutritional status </li></ul>Amputation
  14. 14. <ul><li>Debridement of all Nonviable tissue and foreign material </li></ul><ul><li>Several debridements may be required </li></ul><ul><li>Primary wound closure often contraindicated </li></ul><ul><li>High voltage, electrical burn injuries require careful evaluation because necrosis of deep muscle may be present while superficial muscles can remain viable </li></ul>Techniques Amputation
  15. 15. <ul><li>Nerve </li></ul><ul><ul><li>Prevent neuroma formation </li></ul></ul><ul><ul><li>Draw nerve distally, section it, allow it to retract proximally </li></ul></ul><ul><li>Skin </li></ul><ul><ul><li>Opportunistic flaps </li></ul></ul><ul><ul><li>Rotation flaps </li></ul></ul><ul><ul><li>Tension free </li></ul></ul><ul><ul><li>Skin grafts </li></ul></ul>Techniques Amputation
  16. 16. <ul><li>Bone: </li></ul><ul><ul><li>Choose appropriate level </li></ul></ul><ul><ul><li>Smooth edges of bone </li></ul></ul><ul><ul><li>Narrow metaphyseal flare for some disarticulations </li></ul></ul><ul><li>Postoperative Dressing: </li></ul><ul><ul><li>Soft </li></ul></ul><ul><ul><li>Rigid </li></ul></ul>Amputation Techniques
  17. 17. <ul><li>Goals of Postoperative Management </li></ul><ul><ul><li>Prompt, uncomplicated wound healing </li></ul></ul><ul><ul><li>Control of edema </li></ul></ul><ul><ul><li>Control of Postoperative pain </li></ul></ul><ul><ul><li>Prevention of joint contractures </li></ul></ul><ul><ul><li>Rapid rehabilitation </li></ul></ul>Techniques Amputation
  18. 18. Techniques… Few examples Amputation
  19. 19. Techniques… Few examples Amputation
  20. 20. After 12 months Techniques… Few examples Amputation
  21. 21. <ul><li>Goals of Postoperative Management </li></ul><ul><ul><li>Prompt, uncomplicated wound healing </li></ul></ul><ul><ul><li>Control of edema </li></ul></ul><ul><ul><li>Control of Postoperative pain </li></ul></ul><ul><ul><li>Prevention of joint contractures </li></ul></ul><ul><ul><li>Rapid rehabilitation </li></ul></ul>Techniques Amputation
  22. 22. Rehabilitation and Prosthetics Amputation
  23. 23. <ul><li>Goals of Postoperative Management </li></ul><ul><ul><li>Prompt, uncomplicated wound healing </li></ul></ul><ul><ul><li>Control of edema </li></ul></ul><ul><ul><li>Control of Postoperative pain </li></ul></ul><ul><ul><li>Prevention of joint contractures </li></ul></ul><ul><ul><li>Rapid rehabilitation </li></ul></ul>Techniques Amputation
  24. 24. <ul><li>1. Residual Limb Shrinkage and Shaping </li></ul><ul><li>2. Limb Desensitization </li></ul><ul><li>3. Maintain joint range of motion </li></ul><ul><li>4. Strengthen residual limb </li></ul><ul><li>5. Maximize Self reliance </li></ul><ul><li>6. Patient education: Future goals and prosthetic options </li></ul>Rehabilitations. Amputation
  25. 25. <ul><li>Up to 2/3 of amputees will manifest postoperative psychiatric symptoms </li></ul><ul><ul><li>Depression </li></ul></ul><ul><ul><li>Anxiety </li></ul></ul><ul><ul><li>Crying spells </li></ul></ul><ul><ul><li>Insomnia </li></ul></ul><ul><ul><li>Loss of appetite </li></ul></ul><ul><ul><li>Suicidal ideation </li></ul></ul>Psychological stress. Amputation
  26. 26. Prosthetics Amputation <ul><li>Myoelectric </li></ul><ul><ul><li>Surface EMG </li></ul></ul><ul><ul><li>Activation delay </li></ul></ul><ul><li>Neuroprosthetics </li></ul><ul><ul><li>Investigational </li></ul></ul><ul><li>Passive </li></ul><ul><ul><li>Cosmetic </li></ul></ul><ul><li>Body Powered </li></ul><ul><ul><li>Harnesses and cables </li></ul></ul>
  27. 27. <ul><li>Preparation </li></ul><ul><li>Good Surgical Technique </li></ul><ul><li>Rehabilitation </li></ul><ul><li>Early Prosthetic Fitting </li></ul><ul><li>Team Approach </li></ul><ul><li>Vocational and Activity Rehabilitation </li></ul>Management of Amputee Amputation

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